COVID-19–In perspective

Bruce Irwin, MD

Today’s guest columnist is Dr. Bruce Irwin.

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The Coronavirus Pandemic has created a great sense of fear in our country.

We fear the unknown: what we do not know or understand.

One of the main causes of fear is the lack of accurate and complete information.

While complete understanding of this Coronavirus Epidemic is in the future. Questions as to how it began and the best way to stop its spread are still being debated. In this debate there is certain information which has not been clearly shared with the general public. All need to be reminded that this is a Medical Problem not a Political Problem.

One of the fears brought forth by government and amplified by the media is that our health care system is overburdened (or shortly will be) and cannot handle the added stress of this epidemic. The current thinking is we should do everything we can to slow the spread down and lower the “curve”.  Not with the illusion that we can stop the virus but the hope we can slow its spread down to a manageable level.

That is true in certain areas of the country but beware of “The Law of Unintended Consequences.”

In many other areas that is not true.  Our population and our health care services are not equally spread throughout the United States.  There has always been a problem with health care maldistribution.

It is ironic, but in the face of the normal seasonal flu epidemic, the onset of seasonal allergies, and now Coronavirus/CV-19, patient visits for almost all health care services and activities, in many areas of the country, have decreased 40% to 50% or more. Some have ceased altogether. Many health care workers including physicians, Advanced Practice Providers (APP), nurses, lab techs, x-ray techs, clerical workers and many others are completely out of work. Most hospitals are no busier than usual for this time of year.

This appears to be primarily as the result of fear.

Fear of many things: mainly fear of exposure to the Coronavirus/Covid 19; the impression and fear that our health care system is overloaded, overburdened and breaking down; that even if they seek health care they will not be seen; and even fear that they are that they are breaking the law if they leave their home.  Except in certain areas, nothing could be further from the truth.

As a result, health care practices are being forced to cut back hours or even close for lack of patients.  Statistically, it is almost certain that by staying home in isolation, afraid to leave and seek medical care, more people will die every day from non-Covid 19 related health care problems than from Covid 19.  By sitting at home in fear, afraid to seek health care and many will die. When all is said and done that mortality rate of these “stay it home deaths” will in all likelihood be much higher than deaths related to Covid 19.

What a waste and a real shame.

Please note the issue of “stay at home deaths” has not been raised or discussed by the media nor government persona.

With the U.S. population at about 330 million there is relatively little illness and death from the Coronavirus (as of this writing there have been approximately 38,000 confirmed cases and 462 Covid 19 related deaths nationwide). Even these numbers are magnified on a national basis when you consider 90% of the cases and deaths are in Washington State, California, and New York City.  It is obvious that NYC and a few other areas are under extreme stress and need help.  However, when there are almost 9 million people living on top of each other, this is not a surprise.  In population density, NYC is the closest thing we have to a Chinese city.  There are definitely other densely populated areas under similar stress and need immediate help but most of the nation is not.

For example, as of this writing, in Alabama, with a population of approximately 5 million, there are about 160 confirmed cases and no deaths from Covid 19.  Most cases are in four densely populated counties (Jefferson 71, Shelby 17, Madison 16 and Lee 16). To our knowledge there have been no deaths or even hospital admissions directly related to Covid 19.  Doctors office visits are way down and as noted, some Physicians and Advanced Practice Providers (APP) are completely out of work. Hospitals in Alabama, except in some areas, are no busier than usual for this time of year.  Most of our country is more like Alabama than NYC.

In addition, the numbers related to confirmed cases are almost useless in determining the severity of this epidemic. The number of confirmed cases is greatly affected by the number of tests done, where they are done, how they are done, frequency of test, and the number of invalid test results, as is mentioned below.  Currently, following the number of deaths is the most accurate methodology to determine severity and even that number can be laden with error as to the exact cause of death.

Our current problems with Covid 19 are compounded by maldistribution and lack of accuracy of Coronavirus testing.  The tests currently in use are so few as to be almost non-existent. In addition, the current tests are fraught with difficulties.  Specimens are often incorrectly harvested and therefore invalid.  Also, there is a significant level of false negatives and false positive test results. Many people initially test negative only to be positive on later test.  There are other tests available on the world market approved by the WHO but our CDC does not recognize the WHO’s validation of these test and initially insisted on developing and producing their own. There are millions of test being produced by other countries including Germany, South Korea, and China awaiting shipment to the U.S. pending FDA, CDC, and other bureaucratic processes. This is despite these tests having been validated by use in other countries.  In addition, many companies in the U.S. are rapidly developing and ramping up production of Coronavirus tests, but they face the same obstacles.

Despite the short comings of the test and more important, who do you test?  Do we test the symptomatic, the elderly and the ill only?  What about the rest of our population? We know that in the vast majority of cases people infected with the Coronavirus do not progress to the full blow illness. An estimated 60% of infected individuals have no or only mild symptoms and do not seek medical help and therefore go undetected. At most it is like a cold and goes away without the knowledge or realization that they have been infected by the Coronavirus. There are likely thousands, tens of thousands, hundreds of thousands, if not millions of such people walking about in the US and in the world right now. Many of these can still pass on the Coronavirus.

There are people exposed but not infected, exposed and infected but not ill, a few exposed and become mildly sick, a few more become seriously ill and a very few, with concomitant health care problems, can become very ill and a very, very few will die.

So, what do we do, test everyone?  And then what do we do?

Even if we could and did test everyone, will the test help?  We have no known effective treatment, no vaccine.  Do we quarantine all the positives? And what about the false negatives, when and how often do we retest?

Or do we do what we did in the beginning of this epidemic and in the past, tell them: if you are sick, stay home and avoid other people. If you get worse seek medical help.

So we are back to the beginning.

In previous viral epidemics, we responded with ‘mitigation’ of the problem.  We instructed  people to do the sane things: everyone get a flu shot (it is still the most common cause of infectious disease this time of year, easily diagnosed and treated);  if you are elderly or have pre-existing illness, stay home as much as possible and avoid personal contact;  wash your hands frequently; don’t touch your face; don’t shake hands; sneeze into a tissue or your elbow;  avoid crowds; if you are sick, stay home and do not go to work; call or see your physician as needed.

We monitored the most vulnerable ones in our society for the development of concomitant illness.  If they began to get ill, it was quickly identified, treated and deaths were minimized.

This was the best advice then and now.

Yes, our healthcare system was put to the test.  Medical personnel worked long and hard hours doing what they are trained to do, to take care of people and not stand around waiting on the Apocalypse.

And yes, there were deaths but they were minimized.

Our society did not come to a halt nor did our economy go into a death spiral as is presently happening.

And with time our society and economy recovered.

There are very smart people involved at all levels of our government making these decisions but all should remember this is a Medical Problem not a Political Problem.

It is still difficult to fathom the need for such nationwide draconian measures as are currently in place.

And, what if they do not work?

Then we are back to mitigation and doing as we have in the past.

In the end, we will be fine.

Our people and our country are strong.

Our society and economy will recover, but at what cost?

Bruce Irwin, M.D., a life long resident of Birmingham, is the Founder and CEO of American Family Care (AFC). 

AFC is of the oldest and largest Urgent Care/Primary Care companies in the U.S. AFC/Hoover, opening June 14, 1982, was the first such clinic in Alabama.   AFC has since grow to over 235 offices in 25 states including 18 offices in the Greater Birmingham Area and 65 offices statewide, from Huntsville to Orange Beach. 

 He and his wife, Carla, have six children and 6 grandchildren.

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David Sher is Co-Founder of AmSher Compassionate Collections.  He’s past Chairman of the Birmingham Regional Chamber of Commerce (BBA), Operation New Birmingham (REV Birmingham), and the City Action Partnership (CAP).

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9 thoughts on “COVID-19–In perspective”

  1. Dr. Irvin, this was a great article which could help to put this current virus problem in perspective and lead to intelligent responses.

    However, with such a huge percentage of the current inhabitants of the land of the formerly free and the home of the formerly brave believing that government is the solution to all problems, they all are also political problems.

    And, while each media outlet puts its own right wing or left wing political spin on every news article, they all sensationalize every problem because bad news sells better than good news.

  2. If you are so sure please come down to UAB and help out. We are currently approving Disaster Privileges and will be happy to put you and other healthcare providers to work!

    1. I think this is a great idea! Instead of trying to de-escalate a concern bc you don’t buy what’s on the news, become an active part of what’s actually happening.

  3. Cut back on staff and allow them to travel to the places that need them. A nurse I know has it and is waiting on a test to confirm it. She coughing up pink foam. Her phone is “ringing off the hook” with offers to travel. Offers are around $100/hour. Send your staff to the places needed. ☺️

    1. I’m so sorry your friend is suffering 🙁 I hope she gets the help she needs, and we can rally other local healthcare providers to provide help where it’s needed.

  4. The doctor’s observations certainly are inconsistent with most everything that other health care professionals in Birmingham are saying. I think it would be helpful to ask Dr. Saag or some other local infectious disease expert to share their thoughts.

  5. Feel the same now—July 2020? We do need more centralized federal strategies to deal with this major public health crisis. The US had been negligent in protecting its citizens.

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